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Floating  Minute  Organic  Matter  in  the  Air 

AND  ITS  MANAGEMENT  TO  PREVENT 

Disease  and  to  mitigate  or  control  it,  with  a  new 

DEVICE  FOR 

ATMOSPHERIC  PURIFICATION. 

- ;WITH  AN  ORIGINAL  ILLUSTRATION,: - 

By  David  Prince,  M.  D.,  of  Jacksonville,  Illinois. 

As  to  the  number  of  microbes  in  the  air,  some  reliable  infor-  . 
mation  is  to  be  obtained  from  some  recent  observations  by  M. 
Miguel  in  a  publication  reviewed  by  M.  Hacbe  in  the  Revue  de 
Chirurgie  for  May  and  June,  1884. 

By  these  observations,  what  was  known  before  in  relation 
to  the  influence  of  the  weather  is  further  confirmed. 

The  spores  of  the  mould  and  cryptogams  arc  especially  vari¬ 
able,  being  most  prevalent  in  damp  weather.  On  the  other  hand, 
the  8ej)tie  microbes  are  least  abundant  during  the  rainy  periods 
and  most  abundant  during  the  periods  of  drouth. 

The  average  number  of  microbes  found  in  the  air  at  M^t 
Souris  (  near  Pari.s  )  was  84  to  the  cubic  metre  of  air.  In  ap¬ 
proaching  the  centre  of  the  city,  the  number  was  found  to  in¬ 
crease,  being  ten  times  that  outside  of  tlio  city. 

A  series  of  observations  was  made  at  the  top  of  the  Pantheon, 
250  feet  high,  which  showed  that  the  air  was  more  pure  there 
than  at  M’t  Souris,  and  ten  times  less  charged  with  microbes 
than  that  on  the  surface  in  the  centre  of  the  city. 

In  the  interior  of  the  well-kept  habitations,  the  microbes  in¬ 
crease  during  cold  weathfer  at  the  same  time  that  they  diminish 
in  the  free  atmosphere. 

To  give  an  example  of  the  enormous  aecurn illation  in  appar¬ 
ently  well-kept  houses  in  populous  centres,  observations  were 
made  in  the  lourth  story  of  a  house  recently  built,  in  a  bed- 


Re print e,d  from  the  St.  Louis  Medical  and  Surgical  Joui'naf  February.^  1885* 


— 2- 

room  occupied  only  twelve  hours  of  the  twenty-four,  and  there 
was  found  to  be  the  large  number  of  526  microbes  to  the  cubic 
metre  of  air,  while  in  a  room  similarly  situated  at  Ml  Souris 
there  were  only  325. 

In  hospitals, ‘microbes  have  been  found  by  M.  Miguel  to  the 
number  of  6,300  to  the  cubic  metre.  At  the  Hotel  Dieu,  5,123 
in  the  summer  and  at  the  Hopital  cle  la  Pitic  an  average,  by 
the  year,  of  11,100. 

The  microbes  found  in  surgical  wards  abound  especially  in 
the  form  of  micrococcus.  The  microbes  cultivated  and  inoculated 
into  animals  generally  proved  harmless,  but  in  some  rabbits  and 
guinea  pigs,  grave  affections  were  produced. 

The  dust  deposited  upon  objects  waa  found  to  contain  mi¬ 
crobes  to  the  number  of  750,000  1  )  1,300,000  to  the  cubic  metre. 

The  question  is  discussed  by  the  author  and  his  reviewer, 
whether  the  different  forms  of  microbes  are  originally  of  differ¬ 
ent  species  and  varieties,  or  whether  they  are  capable  of  develop¬ 
ing  or  degenerating  from  one  form  and  character  into  another. 
M,  Miguel,  M.  Cohn  and  M.  Noegali  are  quoted  as  having 
investigated  the  subject,  the  latter  of  whom  is  quoted  thus: 
‘‘I  am  well  convinced  that  too  many  species  have  been  dis¬ 
tinguished  among  the  schismocetes.  It  seems  to  me,  on  the 
other  hand,  somewhat  probable  that  all  the  schismocetes  consti¬ 
tute  one  natural  species.  There  may  exist  among  them  a  small 
number  of  genera  or  species  now  recognized  of  which  each 
passes  through  a  cycle  of  forms. 

M.  Hache  goes  on  to  say,  that  successive  cultures  can  pro¬ 
foundly  modify  the  mode  of  their  physiological  activity. 

Examples  are  quoted  of  the  metamorphosis  of  the  compara¬ 
tively  innocent  hay  bacillus  (or  bacdlus  subtiiis)  into  the  microbe 
oranthrax  or  splenic  fever,  which  is  one  ot  the  most  virulent  of 
the  yftthogenic  forms. 

Finally,  the  cultivations  of  Pasteur  are  referred  to  as  a  proof 
of  this  position.  On  the  other  hand,  Klein,  in  a  series  of  articles 
in  recent.n  unbers  of  the  Practitioner,  which  have  been  published 
also  by  McMUlan  in  book  form,  claims  that  in  those  cultures  in 
which  septic  microbes  seem  to  have  been  converted  into  pathoge¬ 
nic  microbes,  and  vice  versa,  there  has  not  been  sufficient  care  to 
secure  purity  of  ulture;  that  the  kinds  have  become  mixed  to 
such  an  extent  as  o  destroy  the  value  of  the  observations. 

Many  carefully,  made  observations  and  noino  diagrams  are 


^presented  in  the  article  by  M.  Mii^iiel  to  show  that,  in  the  main, 
the  amount  of  disease  prevailing  among  people  is  proportionate 
to  the  number  of  minute  organisms  floating  in  the  air ;  the 
greater  amount  of  mortality  in  tie  centre  of  large  ci^Jes  corres¬ 
ponding  with  the  greater  number  of  floating  microbes. 

One  reason  for  this  may  be  that  cities  furnish  iniJecaying 
organic  substances,  the  culture  media,  for  the  propagation  of 
the  dangerous  forms  of  microbes,  while  in  the  country  the  decay¬ 
ing  material  is  chiefly  vegetable  and  fitted  for  the  development 
of  the  zymotic  and  septic  varieties,  and  equally  unfiitod  for  the 
development  of  those  microbes  which  are  known  to  produce 
specific  diseases,  the  most  common  of  which  is  erysipelas. 

According  to  present  knowledge,  the  organic  objects  floating 
in  the  air  may’ be  classified  as  : 

1.  The  spores  of  objects  many  of  which  are  to  be  seen  with 
low  powers.  These  became  familiar  to  the  earliest  observers 
with  the  microscope,  as  the  yeast  plant. — Zymoitc  Agents,  . 

2.  The  spores  and  sometimes  the  developed  forms  of  a  class 
requiring  higher  and  sometimes  the  highest  powers  to  see  them, 
which  produce  in  nitrogenized  organic  material  the  phenomena 
of  putrefaction  but  have  no  power  of  attacking  living  tissue.  As, 
bacterium  termo,  hay  bacillus — Septic  Agents, 

3.  The  spores  and  sometimes  the  developed  objects  of  a  class 
generally  requiring  high  powers  for  their  observation,  which  pro¬ 
duce,  when  introduced  into  living  tissues,  or  their  fluids,  changes 
characterized  by  the  phenomena  of  special  disorders,  as  erysipe¬ 
las,  hospital  gangrene,  anthrax,  tuberculosis,  etc. — Pathogenic 
Microbes, 

In  the  following  named  diseases,  this  contagium  has  be- n 
proved  to  be  particulate  and  vital,  capable  of  mutiplying  and 
perpetuating  its  kind  when  temperature  and  sustenance  i^^nder 
it  possible. 

These  are,  various  septic  developments,  and  erysipelas,  hos¬ 
pital  gangrene,  small-pox,  diphtheria,  gonorrhcea,  Koch^s  septi- 
ciemia  of  mice,  Davaine's  septicaemia,  chicken  cholera,  swine 
cholera,  leprosy,  Koch^s  malignant  oedema,  8  nthrax,  actinomy¬ 
cosis,  tuberculosis,  relapsing  fever  and  Asiatic  cholera.  The 
last  lacks  the  proof  of  successful  inoculatio  as  after  a  series  of 
cultivations. 

From  this  it  is  probable  that  all  other  contagious  and  in  fee- 


—4 


I 

) 

\ 

I 

tious  diseases  are  originated  a*hd  repeated  by  the  action  of  simi-  / 
lar  particulate  vital  agencies. 

DIGESTION. 


Dr.  G.  y.  Black,  in  his  book  on  ‘‘The  Development  of  Poi¬ 
sons  through  Micro-Organisms  has  helped  to  generalize  the 
conception  of  the  manner  in  which  living  things  appropriate  nu¬ 
triment  from  surrounding  food  material.  The  amoeba  converts  a 
portion  of  its  exterior  into  a  temporary  stomach  by  investing 
an  object  sufficiently  small  and  digesting  it,  so  that  the  nutritive 
elements  of  it  may  be  absorbed.  In  accordance  with  the  same 
idea,  an  object  smallei  *han  a  blood  cell  comes  in  contact  with 
the  tissues  of  the  body.  If  the  Vi^al  condition  of  the  tissue  is 
sufficiently  strong,  the  minute  object  may  be  digested.  If,  on  the 
other  hard,  the  vital  force  is  weak,  the  cell,  with  which  the 
invader  comes  in  contact,  is  digested  and  the  invader  by  natural 
increase  becomes  a  spreading  colon}',  appropriating  more  and 
more  of  the  adjacent  substance.  If  several  individual  invadei’s 
gain  entrance  at  tiio  same  time,  the  conquest  is  more  rapid.  It 
a])pears  from  the  researches  of  Pasteur,  Koch  and  others,  that 
differert  microbes  have  different  degrees  of  power  in  the  attack. 
The  septic  micrococci,  bacteria,  and  bacilli  being  only  capable  of 
attacking  i^^aterial  destitute  of  presontvitality,  while  they  are  in¬ 
capable  of  invading  living  substance. 

There  are  minute  living  object=^,  most  commonly  floating  in 
the  air,  of  many  species  or  varieties  and  capable  of  living  upon 
albuminoid  material.  In  accordance  with  this  idea,  a  blood  clot 
exposed  to  thp  air  and  left  in  the  wound  may  become  the  seat  of 
se})tic  changes,  w  hile  the  lips  of  the  same  wound  brought  together 
without  any  intermediate  clot,  thou^^h  exposed  to  the  samegerm- 
bcai’ing  atmospheric  contact,  may  digest  the  invading  organ-| 
isms  and  heal  by  the  firist  intention.  The  blood  clot,  however, 
having  no  such  vital  power  of  resist  mce,  may  go  into  a  state  of 
putrefaction  and  become  a  source  of  irritation  and  infection  to 
the  adjacent  living  surface.  Again,  f  the  supposed  blood  clot  is 
secluded  from  air  containing  organisms,  or  if  the  vitality  of  these 
Invaders  is  neutralized  by  some  antiseptic  agent,  as  carbolic  acid 
or  mercuric  bichloride,  the  clot  fails  to  go  into  putrefaction  and 
becomes  pene  rated  by  a  living  projecting  growth,  secreting  a 
soluble  ferment,  by  which  the  clotiu  digested  and  brought  into  a 
condition  of  solution  to  be  absorln  I  j.  nd  carried  away.  In  this 


'4 


— 5— 


view,  the  question  of  the  innocence  of  :  biood  clot  turns  u}3on 
the  fact  of  its  exposure  to  the  atmospherii  'rfranisms  in  a  condi¬ 
tion  in  which  they  can  appropriate  its  nn  ritive  material  and 
thrive  upon  it.  If,  in  a  peritoneal  cavity,  a  clot  has  had  such  an 
exposure  it  will  probably  go  into  a  conditioi  of  putrefaction.  li', 
on  the  other  hand,  through  the  absence  of  or  .nanisms  brought  by 
the  air,  or  through  their  neutralization  by  a-i  '  iseptic  agents,  the 
seeds  of  putrefaction  are  absent  or  inactive,  the  clot  will  become 
ultimately  permeated  by  leucocytes,  dige^  ed  and  absorbed. 
The  same  thing  happens  with  catgut  ligatures,  with  sponge,  or 
other  substance  which  the  tissues  have  the  }  r»wei  of  dissolving 
by  the  production  of  an  appropriate  digestive  liuid.  Oatgut  may 
be  said  to  bo  easy  of  digestion,  so  that  it  dir-  ppear."  in  few  days. 
Silk  is  more  difficult  of  digestion  and  is,  the!*ei'orc,  more  i  ible  to 
result  in  an  abscess  for  its  ultimate  expulsion.  Linen  is  more 
difficult  still  of  digestion  and,  therefore,  more  liable  than  silk  to 
the  formation  of  an  abscess.  Silver  is  again  aL'’olutely  indiges¬ 
tible,  while  it  is  unirritating  and  may  innoceniiv  remain  any 
length  of  time  in  contact  with  living  tissue. 

A  catgut  ligature  or  a  blood  clot  containing  septic  germs,  is 
almost  certain  to  proceed  to  putrefaction,  unless  from  the  small¬ 
ness  of  volume,  the  living  tissues  may  be  capable  of  -jurrounding 
the  germs  and  infiltrating  the  clot,  catgut  or  other  substance  con¬ 
taining  them,  with  a  digesting  agent  capable  of  destroying  the 
vitality  of  the  microbes;  of  dissolving  and  carrying  away  both 
them  and  their  store  of  food. 

As  these  agents,  either  in  their  developed  cij  in  their  germ 
state,  float  everywhere  'ti  the  air  without  the  possibility,  by  any 
means  hitherto  practiceu,  of  completely  excluding  them,  except 
on  a  very  small  scale,  thMr  entrance  to  some  extent  into  every 
open  wound  is  a  matter  of  course. 

This  consideration  po-nts  to  the  importance  of  the  employ¬ 
ment  of  local  antiseptics  during  the  progress  of  t>peration8  atten¬ 
ded  by  incisions  and  as  long  afterwards  as  the  wound  remains 
open.  The  antiseplics  ;  re  employed  in  the  form  of  spray  or  of 
a  continuously  flowing  stream. 

The  danger  is  greater  when  the  invaders  are  not  simply  the 
/agents  of  sepsis,  but  ar«>  the  paihogenic  microbes  of  erysipelas, 
hospital  gangrene  or  other  infecuous  disease. 

‘  These  are  proved  to  hav  3  a  capability  of  attacking  living  tis¬ 
sues  and  of  nroducing  by  the  employment  of  a  stronger  diges- 


/ 


— 6— 


tivo  agenl,,  the  destruction  and  appropriation  of  live  cells  and 
dxed  tisSuo,  without  any  other  natural  limit  than  the  whole  extent 
of  thel  t^y  attacked. 

If  %ae  invading  agent  be  very  small  in  amount  and  the  vital 
conation  of  the  patient  be  perfect,  the  invaders,  if  not  repulsed 
ov  destroyed  in  the  very  entrance,  may  be  limited  to  the  forma- 
iOn  of  an  abscess,  while,  if  the  vitality  of  the  patient  be  feeble, 
the  smallest  invasion  may  end  in  the  complete  destruction  of  the 
system.  This  may  be  the  reason  why  a  dissecting  wound  pro¬ 
duces  a  minute  abscess  in  one  person,  an  abscess  with  a  slight ' 
fever  in  a  second,  and  a  fatal  blood-poisoning  in  a  third.  The 
difference  lies  in  the  power  of  resistance,  and  not  in  the  nature  of 
the  invaders. 

The  use  of  medicinal  agents  taken  by  the  mouth  cr  ijijected 
into  the  tissues  and  vessels  has  for  its  object  the  increase  of  the 
power  of  resistance,  as  when  we  combat  erysipelas  by  the  inter¬ 
nal  employment  of  chloride,  of  iron. 

The  local  applications,  on  the  other  hand,  generally  have  for 
their  object  the  destruction  of  the  invading  agents. 

The  local  agent  applied  in  anticipation  may,  however,  have  a 
two-fold  effect;  first  to  destroy  or  render  inactive  the  atmosphe¬ 
ric  living  agents,  and  next  to  preserve  the  vitality  of  the  incised 
or  lacerated  surfaces,  so  that  tLo  invaders  may  be  destroyed  by 
the  defensive  fluid  secreted  by  the  living  surfaces. 

A  stream  of  the  aqueous  solution  of  carbolic  acid  of  the 
Btrength'of  1  to  100,  of  mercuric  bichloride  of  a  strength  of  1 
to  1,000,  or  1  to  10,0-^K)  does  t  necessarily  destroy  the  spores 
of  septic  and  pathogenic  microbes,  but  it  destro\’8  the  present 
activity  of  those  which  are  in  a  developed  and  active  condition. 
It  at  the  same  time  preserves  the  moisture  and  the  unimpaired 
condition  of  the  exposed  surfaces,  so  that  the  invading  germs  arc 
immediately  surrounded  by  a  secretion  of  a  strong  character 
^  \  which  invests  the  invading  germs  and  digests  them.  A  stream 
of  pure  water  would  have  the  same  effect  upon  the  incised  or 
J^cerated  surface,  only  to  be  sure  of  its  freedom  from  organic  life 
V  "  iti^nnsthave  been  recently  boiled  for  more  then  thirty  miuutes. 
^vlciii  Tn  his  little  book  recently  published,*  slates  that  distilled 
Wi;fer  beximes  in  a  few  hour’s  full  of  septic  microbes  in  an  active 
devoiOpep  state,  ready  to  multiply  and  flourish  when  introduced 


into  any  substance  furnishing  oxygen,  nitrogen,  and  hydrogen, 
i.  e.  any  natural  animal  or  vegetable  substance. 

There  are  numerous  illustrations  of  the  powei  if*  rp.  istance 
of  living  tissues  against  organisms  which  are  sim^^My^  septic  in 
their  character.  ' ^ 

It  is  probably  rare  that  a  h^'podermic  injection  ot  4iny  sub¬ 
stance  is  made  without  introducing  at  the  same  time  a  bubble  ol 
air  containing  a  colony  of  micro-organisms,  either  as  germ*  or  in 
a  developed  condition ;  yet  the  formation  of  an  abscess  ?  r  a 
more  severe  general  septic  poisoning  is  an  exceedingly  rare 
currence.  These  agents  must  be  devoured  as  they  are  surrounded 
by  a  stronger  vitality. 

The  introduction  of  air  on  a  very  large  scale  occurs  after 
wounds  connecting  the  respiratory  passages  with  the  surround* 
ing  connective  tissue,  and  yet  the  air  is  generally  absorbed  with¬ 
out  evil  consequences. 

However,  if  instead  of  common  air  it  be  loaded  with  the 
floating  products  of  erysipelas,  puerperal  or  other  septic  fevei- 
or  hospital  gangrene,  the  hypodermic  injection  might  introduce 
an  enemy  of  greater  destructive  force,  capable  of  appropriating 
and  living  upon  the  surrounding  cells  and  fixed  tissues,  the  vi¬ 
tality  of  which  it  overmasters. 

Again,  if  the  patient  is  in  a  condition  of  very  feeble  vitality, 
the  minute  blood  clot  occasioned  by  the  point  of  the  needle  nsay 
afford  an  insufficient  resistance  to  the  relatively  superior  vital 
force  of  the  invading  microbes,  though  only  of  the  septic  class. 

In  view  of  these  facts  and  reasons,  the  most  important  consi¬ 
deration  in  relation  to  surgical  (or  accidental)  wounds  is  the 
purity  of  the  atmosphere,  or  its  freedom  from  microbes,  especi¬ 
ally  those  of  a  pathogenic  nature.  The  latter  are  very  apt  to  be 
present  in  houses  which  have  been  contaminated  by  erysipelas 
and  by  those  septic  fevers  which  are  attended  by  the  presence  of 
pus  in  a  putrefactive  condition,  while  the  out-door  air  or  the  air 
of  an  apartment  not  used  for  dwelling  purposes,  is  likely  to  liave 
only  those  microbes  which  are  capable  of  starting  putrefactior 
in  non-vital  animal  and  vegetable  substances. 

The  second  most  important  consideration  is  the  h  jalth  of  the 
patient,  or  his  power  of  resisbnice  to  the  ordinary  septic  influ¬ 
ences  which  are  almost  everywhere  present. 

The  power  of  medicines  to  increase  the  resistance  is  not  here 
paroper  subject  to  consider  j  suffice  it  to  say,  that 'a  greal^consid- 


eration  is  the  neutralization  of  the  latent  malarial  poison  ready 
to  develop  on  any  occasion  of  depressed  vitality. 

The  management  of  diet  is  of  equal  importance,  but  not  in 
.  the  scope  of  consideration  to  be  entertained  here.  The  diet  which  ^ 
for  the  time  secures  the  best  state  of  health,  or  the  management 
which  secures  a  demand  for  nutriment  and  a  capability  of  diges¬ 
tion  and  assimilation,  are  expr  *-^ive  of  the  end  to  be  secured. 

The  third  consideration  is  t  of  the  local  management  of  a 
wound — There  are  three  things  ;  (1.)  to  protect  the  surface  from 
drying  and  the  consequent  tendency  to  die  and  become  the  seat 
of  septic  changes.  This  is  done  by  a  spray  or  by  irrigation,  or 
by  the  presence  of  a  clot  which  should  not  needlessly  be  wiped 
off  until  the  time  for  the  final  dr  ‘ssing. 

(2.)  The  presence,  in  the  fluid  of  the  spray  or  irrigation,  of 
some  agent  which  d-'stroys  or  temporarily  neutralizes  the  float¬ 
ing  organic  substances  in  the  atmosphere.  It  is  probable  that 
the  best  agent  yet  tried  for  the  purpose,  is  an  aqueous  solution 
of  mercuric  bichloride,  and,  as  the  result  of  experience,  a  strength 
of  1  to  10,000  for  a  prolonged  contact. 

The  agent  can  be  applied  without  injury  to  the  vitality  of 
the  exposed  wound  surtaces,  and  while  too  weak  to  destroy  the 
vitality  of  the  eporc'^  of  pathogenic  microbes,  it  is  suflSciently 
strong  to  nullify  their  present  activity  and  prevent  the  immediate 
production  of  their  digestive  soluble  ferment.  The  substances  to 
be  applied  to  wouniis  to  prevent  subsequent  septic  development 
arc  boric  acid  and  iodoform.  The  latter  is  capable  of  being  intro¬ 
duced  into  a  wound  without  interfering  with  union  of  the  sur¬ 
faces  by  the  first  intention. 

The  iodoform  is  ultimately  disposed  of  along  with  the  mate¬ 
rial  of  the  coagulum  which  envelops  it.  The  investment  of  the 
wound  with  borated  cotton  affords  a  material  which  retards  or 
prevents  putrefaction  in  the  effusions  and  exudations  escaping 
from  the  wounds  by  openings  or  through  drainage  tubes. 
The  borated  cotton  receives  these  products  and  prevents  their 
putrefaction,  thus  affording  a  material  for  a  dry  dressing  which 
makes  it  practicable  to  subject  a  wound  to  dressings  at  infrequent 
times.  The  baking  slowly  of  borated  or  sublimated  cotton  un¬ 
til  it  assumes  a  light  brown  color,  is  found  to  afford  a  dressing 
in  which  the  exudations  which  have  escaped  from  a  wound  and  ^ 
become  dry  do  not  putrefy.  ■ 

Ix  t^a  wet  dressing,  there  is  nothing  yet  known  superior  to  a  , 


drip  of  carbolic  acid  of  one^er  cent,  strength,  applied  coit'^  Sntlj)' , 
or  at  times  not  more  than  20  minutes  apart,  in  order  that  the^ifes- 
ence  of  the  agent  may  be  perpetual.  '  This  is  incapable  of  desttc^-  , 
ing  spores,  but  is  yet  strong  enough  to  prevent  the  activity  or 
vital  manifestation  of  the  septic  microbes,  and  is  probably  capable 
of  suppressing  the  vital  manifestations  of  those  of  a  pathogenic 
charat  ter,  or  those  having  the  power  of  producing  specific  dis¬ 
eases.  a.s  those  of  eiysipelas,  hospital  gangrene  and  other  dis¬ 
ease.'^,  many  of  which  have  not  yet  been  carefully  studied,  while 
yet  the  applications  are  weak  enough  not  to  injure  the  surfaces 
to  which  they  are  applied. 

Ii  s  not  the  purpose  of  this  paper  to  go  much  into  detail,  but 
to  indunt-e  in  a  brief  way,  the  advance  of  thought  upon  the  sub¬ 
ject,  fused  upon  the  careful  investigations  .which  have  proved 
beyond  dispute  the  dependence  of  many  diseased  manifestations 
upoi.  the  presence  of  micro-organisms. 

Tiie  conception  of  digestion,  as  the  means  by  which  micro- 
orgfiKi.sms  are  enabled  to  attack  and  live  upon  substances  that 
go  ini'!  decomposition  in  connection  with  their  growth  and  mul- 
tipl'-axiou,  is  further  developed  by  Dr.  Black  in  his  book,*  pp 
50  A:  85. 

C^iuming  from  Lister,-}*  he  states  that  this  observer  found  that  a 
few  germs,  of  the  species  of  bacterium  found  in  the  hydrant  water 

If  London,  contained  in  a  single  drop  of  water,  could  not  start 
kcomposition,  but  a  larger  amount  could.  At  the  same  time,  the 
piallest  amount  of  putrid  material  would  start  decomposition, 
he  explanation  approached  by  Lister  and  clearly  stated  by  Dr. 
Black,  is  that  in  the  detached  state,  a  bacterium  is  not  able  to 
develop  a  ferment  in  sufficient  amount  or  intensity  to  overcome 
the  chemical  union  of  the  serum,  but  when  introduced  insufficient 
number  to  unite  their  digestive  products,  or  in  a  condition  in 
which  the  individual  organisms  are  already  surrounded  by  their 
ferment,  they  are  able  to  attack  the  serum,  living  upon  it  and 
multiplying  in  it. 

This  consideration  has  an  important  surgical  relation.  In  this 
view,  it  is  not  necessary  that  an  agent  acting  as  an  antiseptic 
should  be  capable  of  destroying  the  micro-organism.  If  it  is 
capable  of  neutralizing  the  digestive  ferment  produced  by  th^; 

*  Formation  of  Poisons  by  Micro-Organisms.  Presley  Blakistoni, 
Son  &  ('o.,  1884. 

t  Transaciions  of  the  International  Medical  Congress,  Loirlon,  1^81. 


—10— 


attacking  micro-organism,  the  development  and  multiplication  ot 
the  microbe  may  be  held  in  check  until  destroyed  by  the  diges¬ 
tive  action  of  the  cells  of  the  surface  of  the  wound  invaded. 

The  fact  that  spores  will  live  in  alcohol,  and  afterward  thrive 
when  planted  in  a  good  field,  does  not  militate  against  the  uselul- 
ness  of  alcohol  as  an  antiseptic,  however  poor  a  disinfectant  it 
may  be.  By  way  of  reference  to  the  alphabet  of  the  subject,  tiic 
facts  known  of  the  nature  of  the  poisons  evolved  by  micro-or¬ 
ganisms  imply  that  by  their  nature  and  their  modes  of  action 
they  may  be  arranged  in  three  classes. 

1.  The  local  effects  of  a  digestive  fiuid  by  which  the  cells 
attacked  are  paralyzed  and  then  destroyed.  When  the  invad¬ 
ing  organisms  are  circulating  in  the  blood,  they  infiltrate  the 
white  blood  corpuscles  and  destroy  them.  A  period  of  incuba¬ 
tion  elapses  between  the  invasion  and  a  sufficient  multiplication 
of  the  microbes  to  produce  a  manifest  local  disease  or  to  affect 
the  general  health. 

The  superior  vital  force  of  the  blood  or  tissues  may  arrest  or 
destroy  the  invading  agents.  When  unable  to  do  this,  the  forces  of 
resistance  may  yet  establish  a  wall  of  limitation  so  that  there  may 
be  only  a  local  inflammation  or  a  small  abscess;  and  when  the 
localization  is  less  complete,  the  lymphatics  going  from  the  spot 
affected  may  become  inflamed. 

2.  The  production  of  a  poisonous  waste  product,  wliich,  beij|^ 
taken  up  into  the  circulation,  poisons  in  analogy  with  morp^H 
and  strychnia,  which  alkaloids  in  this  view,  may  be  classed^* 
alkaloid  waste  products  of  the  poppy  and  the  strychnos.  ^ 

The  inoculation  of  such  a  poisonous  waste  product  produces 
immediate  disease  without  an  intervening  period  of  incubation. 

Sepsin,  the  waste  product  of  septic  action,  when  filtered  out 
from  the  microbes  which  produce  it,  immediate!}'  produces  gen¬ 
eral  disease  when  inoculated,  though  there  is  nothingjiving  in  it 
by  which  it  can  bdi  multiplied  or  reproduced  by  the  processes  of 
cultivation.  Thisiimpossibility  of  cultivation  shows  that  the  poi¬ 
son  has  been  separated  from  the  vital  agents  which  have  pro¬ 
duced  it. 

The  entrance  ofHepsin  in  sufficient  quantity,  whether  gener¬ 
ated  in  a  wound  or  ji;oer,  or  injected  artificially,  destroys  life,  but 
if  insufficient  for  this,  recovery  takes  place  as  in  the  case  of  other 
poisons. 

3.  Pathogenic  poisons  areUhose  of  special  diseases  which  are 


/ 


supposoa  to  arise  from  microbes  of  peculiar  species  on  one  theory, 
or  on:  another  theory,  such  rs  ar  profoundly  modified  by  the 
tem])erature  and  the  food-media  with  which  their  growth  and 
multiplication  have  been  circumst  need. 

These  microbes  are  called  by  Klein  pathogenic  to  distinguish 
them  from  microbes  which  pro-^uc  only  septic  effects  and  which 
are  called  septic  microbes.  All  these  pathogenic  microbes  have 
a  period  of  incubation,  some  lo*  ger  and  some  shorter. 

During  this  period  of  incubation,  the  invaders  are  living  upon 
the  tissues  at  the  point  of  entrance,  multiplying  and  extending, 
or  if  floating  in  the  blood,  they  are  attacking  the  white  blood 
corpuscles  in  greater  and  greater  number.  According  to  their 
nature  they  produce  different  dib“\8es. 

Some  cause  a  gangrene  as  they  travel  and  are  very  local,  until 
the  system  becomes  attacked  by  sc  ptic  poisoning  from  the  septic 
decomposition  of  whatever  is  destroyed,  while  others  diffuse 
themselves  in  the  blood.  Others,  like  the  bacillus  of  tuberculosis 
and  of  actinomycosis,  lodge  upon  particular  spots,  multiplying 
and  destroying  the  tissues. 

The  mode  of  poisoning  by  atmospheric  micro-organisms  which 
is  most  to  be  feared  in  surgery,  is  that  of  erysipelas,  because  the 
agents  of  this  infection  are  more  abundant  in  dwelling'houses 
and  hospitals  and  most  difficult  to  eradicate.  The  micrococcus 
of  erysipelas  is  extremely  minuU 

As  quoted  by  Klein  (j).  J^S  of  M  cTo-Organisms)  Feheleiscn  cul¬ 
tivated  the  micrococcus  of  erysipelas  through  fourteen  genera¬ 
tions,  and  with  the  last  generation  produced  erysipelas  on  the 
ears  of  rabbits,  and  on  some  tumors  and  lu]mfl  ulcers  of  human 
patients,  the  application  being  nsade  for  the  purpose  of  curing  the 
local  diseases. 

Feheleisen  found  thatathree  percent,  solution  of  carbolicacid 
and  a  or\Q  per  cent,  solution  of  mercuric  bichk  ride  destroyed  the 
vitality  of  this  micrococcus. 

It  thus  appears  why  a  spray  or  irrigatio  of  either  of  those 
agents  upon  a  wound  during  the  progress  jf  its  formation  in 
the  course  of  a  surgical  operation,  is  a  protection  against  an  ery¬ 
sipelatous  contamination. 

The  treatment  of  microbes  in  order  to  destroy  them  or  render 
them  inactive  is  (1)  by  heat  not  less  than  150°  F.  (71°  C),  and 
some  of  them  require  300°  F.  (148°  C),  prolonged  and  repeated } 
(2)  by  disinfectants  which  destroy  the  ^erms  of  the  dangerous 


—12— 


microbes,  and  by  antiseptics  which  hold  their  development  and 
activity  in  check  without  destroying  them.  An  interesting  illus 
tration  of  this  distinction  is  given  by  Dr.  W.  J.  Miller,  of  Dundee, 
Scotland,  in  an  article  on  contagium  in  the  London  Practitioner 
for  Sept.,  1884. 

Dr.  Dougal  suspended  the  action  of  vaccine  lymph  by  the 
incorporation  of  carbolic  acid,  but  when,  by  exposure  to  the  open 
air,  the  antiseptic  had  evaporated  the  l;;j^mph  was  found  to  have 
been  preserved  unimpaired.  According  to  this  and  some  other 
observations  ^‘Carbolic  acid  is  not  a  disinfectant,  not  a  destroyer 
of  organic  matter,  but  rather  an  antiseptic  or  preserver  of  organic 
matter,  arresting  and  preventing  putrescent  and  fermentive 
change,  and  suspending  zymotic  action  for  a  time,  leaving  such 
matter  unchanged  after  the  volatilization  of  the  antiseptic.'^ 

This  distinction  may  be  criticised,  by  saying  that  a  strength 
of  carbolic  acid  of  suflScient  intensity  to  hold  back  and  paralyze 
the  invaders,  may  be  weak  enough  not  to  injure  the  organisms, 
to  be  preserved.  In  the  case  of  vaccine  virus,  it  is  not  injured 
by  a  strength  of  2^  per  cent,  though  the  putrefactive  microbes  arc 
held  in  check.  These  microbes  would  quickly  destroy  the  spec¬ 
ial  contagium  if  not  opposed  by  this  or  some  other  antiseptic.  A 
stronger  preparation  of  carbolic  acid  would  destroy  both  inva¬ 
ders  and  defenders  and  be  a  disinfectant.  A  strength  of  ^  per 
cewf.  preserves  bread  pulp  and  ^  per  cent,  preserves  broth  and  milk. 
Washing  the  hands  in  a  5  per  cent,  solution  is  thought  to  be  the 
weakest  solution  capable  of  protecting  the  hands  against  receiv¬ 
ing  and  imparting  contagium,  and  this  is  far  inferior  to  a  solution 
of  sulphurous  acid.  In  the  form  of  vapor,  however,  it  is  doubt¬ 
ful  whether  carbolic  acid  has  any  effect  whatever  on  account  of 
its  great  dilution. 

All  the  experiments  which  have  been  made  with  carbolic  acid 
vapor  are  negative. 

Among  the  disinfectants,  Dr.  Miller  (above  quoted)  considers 
sulphurous  acid  (from  burning  sulphur)  the  most  valuable  of  all. 
Its  vapor  destroys  every  microbe,  whether  zymotic,  septic  or 
pathogenic. 

Its  gas  permeates  every  crack  in  the  walls  of  a  room,  and  its 
solution  is  easily  applicable  to  the  surfaces  of  solid  bodies.  Its 
only  objectionable  feature  is  the  difficulty  of  employing  it  in 
rooms  while  people  are  in  them. 

It  is  not  necessary  here  to  enumerate  and  compare  even  the 


—13— 


principal  antiseptics  and  disinfectants.  Chlorine,  hydro-chloric 
acid,  iodine  and  bromine  are  powerful  but  difficult  to  manage. 

Salicylic  acid,  boric  acid,  iodoform  and  mercuric  oxides  and 
salts  are  excellent  antiseptics  for  local  application  in  the  solid 
iorm,  the  choice  among  them  being  determined  by  circum¬ 
stance  and  convenience. 

AIR  PURIFICATION. 

We  come  now  to  another  method  of  managing  the  subject. 
Taking  a  hint  from  the  observations  recently  made  in  Paris,  and 
quoted  in  the  beginning  of  this  paper  upca  the  effect  of  rainy 
weather  upon  the  number  of  microbes  floating  in  the  atmosphere, 
it  occurs  to  ask,  whether  or  not  it  is  practicable  to  subject  the 
air  entering  an  operating  room  to  the  influence  of  artificial 
showers  in  order  to  precipitate  lo  the  ground  the  whole  or  the 
greater  part  of  these  enenves  of  surgery. 

They  are  known  to  be  heavi-  r  than  the  air.  because  they  en¬ 
tirely  disappear  from  the  air  within  a  tight  box  which  has  been 
for  several  months  in  one  position.  This  principle  of  rest  is  of 
no  use  to  us,  for  the  purification  of  the  air  of  an  operating  room 
by  this  means  is  impracticable. 

The  dry  filtration  by  means  of  cotton  or  other  substances  to 
entangle  and  arrest  the  particulate  substances  floating  in  the  air,  is 
not  practicable  on  account  of  the  rapidity  necessary  in  the  entrance 
and  exit  of  the  air  in  order  to  displace  the  agents  entering  from 
without  during  the  progress  of  an  operation,  and  those  emanating 
from' the  occupants  of  the  room.  If,  however,  we  can  cause  the 
air  entering  the  room  to  pass  though  several  showers  of  water, 
we  have  an  expedient  which  may  entangle  these  objects  and  carry 
them  to  the  ground. 

The  following  is  a  description  of  sin  4  a  'evice. 

1.  Basement.— On  the  right  hand  is  an  entrjtnce  ventilator,  twenty- 
inches  in  diameter,  in  which  a  stenm  jet  is  u  .ade  to  play  in  order  to  infil¬ 
trate  the  entering  air  with  very  fine  globules  of  vater.  (2)  (3) 

2.  The  air  thus  moistened  passes  in  the  lire  *tion  of  the  arrows  under 
a  curtain  or  diaphragm  reaching  within  fifte  n  inches  of  the  floor.  Under 
this  curtain  lies  an  iron  pipe  with  numerous  small  holes  drilled  in  the 
upper  side.furnishing  an  interrupted  spray  under  the  curtain,  and  making 
it  necessary  for  all  the  moving  air  to  pass  t  i rough  this  artificial  shower 
near  to  the  floor  and  into  the  next  room  varme  i  by  the  stove  seen  on 
the  left  hand  of  the  diaphragm  or  screen.  (3) 

3.  The  air,  thus  warmed,  passes  through  filter,  composed  of  shelves 
of  tliin  muslin  through  which  water  is  dripping.  The  warmed  air 

\ 


—14— 


ih’gt  passes  over  the  top  of  a  vertical  screen  to  avoid  the  entrance  of 
cold  air,  tlien  under  another  vertical  screen,  and  then  back  and  forth 
between  hori/ontal  screens  fifteen  inches  apart,  dripping  with  water  and 
finally  through  the  spray  which  supplies  this  Avater.  (G) 

Thus  there  are  three  filtrations  of  the  air,  one  by  steam  and  two  by 
water. 

4.  The  air  thus  filtered  three  times,  emerges  through  an  opening  in 
the  floor  and  goes  to  the  top  of  the  o])erating  room  above.  [7] 


Fig.  1. 


Basement  below  and  Operating  Boom  a, hove — Scale,  one  to  sixty. 


5.  Operating  Boom. — Tlie  exit  ventilation  is  seen  on  the 
opj^  osite,  or  right  hand  side  of  the  room,  in  the  direction  of  the 
‘arr,o‘v^''8.)  Tliis  is  effected  by  a  movable  shaft  or  box,  made  by 


tacking  muslin  upon  a  frame,  so  that  it  can  be  set  up  against  a 
window,  with  the  upper  sash  pulled  down  to  the  necessary  degree. 
The  shaft  can  be  shifted  from  one  window  to  another  to  be  free 
from  the  pressure  of  the  wind,  or  on  the  opposite  side,  or  from 
the  wind.  The  arrangement  thus  far,  is  to  get  an  atmosphere 
more  pure  than  that  outside,  and  through  the  frequent  change  of 
the  air  in  the  operating  room,  to  get  rid,  to  the  greatest  possible 
degree,  of  the  contamination  of  the  air  (during  the  progress  of 
an  operation)  by  the  emanations  from  surgeons,  assistants,  spec¬ 
tators,  and  the  patient  himself.  This  change  is  secured  by  the 
entrance  of  filtered  air  from  the  basement  and  the  exit,  from  the 
floor  of  the  operating  room,  of  the  air  which  has  been  the  longest 
in  the  room,  having  descended  gradually  from  the  ceiling  where 
the  air  is  hottest,  after  having  entered  from  the  warming  cham¬ 
ber  below. 

6.  The  floor  of  the  operating  room  is  made  of  yellow  pine, 
and  filled  with  paraflin  to  as  great  a  depth  as  heated  smoothing 
irons  can  drive  it.  By  this  means,  all  cracks  are  filled  so  as  to 
be  non-absorbing.  Under  this,  lies  a  layer  of  tarred  paper  upon 
a  cemrnon  floor  upon  the  joists.  Between  the  joists,  lies  a  layer 
of  tarred  paper  upon  the  ceiling,  the  underside  of  which  ceiling 
is  painted,  and  lined  with  muslin  while  the  paint  is  fresh.  The 
muslin  is  again  painted  on  the  under  side.  The  floor  thus  has 
seven  layers,  including  the  joists. 

7.  The  operating  room  is  free  from  closets  where  anything 
unclean  can  be  hidden,  and  all  wood  work  is  either  paraffined  or 
painted. 

8.  There  is  no  opening  into  any  other  room;  about  six  feet 
of  space  intervening  between  the  door  of  entrance  and  the  near¬ 
est  wall  of  the  main  building. 

9.  Before  the  use  of  the  room  for  an  operation  involving 
the  opening  of  a  joint  or  the  peritoneal  cavity,  it  is  intended  that 
the  rooms  above  and  below  shall  be  fumigated  by  sulphur  burn¬ 
ing  in  the  basement.  An  iron  pan  for  this  purpose  is  figured  in 
the  cut(8)  resting  over  a  Bunsen  burner  for  the  combustion  of 
sulphur.  This  is  to  be  done  for  the  destruction  of  any  floating 

I  material  of  an  organic  character  which  may  have  gained  en¬ 
trance  while  the  room  may  have  been  out  of  use. 

It  is  found  by  trial  that  when  the  different  sprays  of  water 
are  going,  one  can  remain  very  comfortably  in  the  room  above 
while  sulphur  is  burning  in  the  room  below  j  the  fumes  bbing  first 


16— 


absorbed  by  the  steam  and  having  then  to  pass  through  the  two 
different  showers  of  water  become  thoroughly  percipitated. 

10.  This  building  is  the  execution  of  a  theory  of  combining 
the  best  known  expedients  for  securing  the  best  possible  atmos¬ 
phere  for  surgical  operations,  by  excluding  noxious  agents  and 
by  destroying  or  expelling  those  which  may  have  stolen  in,  or 
which  may  be  introduced  by  the  patients,  or  by  the  surgeon  and 
his  assistants  and  guests.  It  is  supposed  that  enough  air  will 
enter  and  escape  to  change  the  whole  volume  of  the  air  once  in 
fifteen  minutes.  The  exit  draft  coming  from  the  floor  will  carry 
away  most  of  the  floating  material. 

11.  The  employment  of  a  spray  or  douche  of  carbolic  acid 
of  the  strength  of  4  to  100,  or  of  mercuric  bichloride  of  1  to  10, 
000,  or  other  antiseptics,  locally  applied,  though  less  necessary 
than  in  an  ordinary  room,  may  yet  be  resorted  to  in  order  not 
to  omit  any  useful  precaution. 

12.  The  employment  of  solutions  of  carbolic  acid,  mercu?’ic 
bichloride  or  permanganate  of  potash  with  the  nail  brush  for 
cleaning  the  hands  should  be  supplemental  to  the  fixed  provi¬ 
sions  against  septic  and  pathogenic  particulate  infection. 

13.  The  bathing  of  the  instruments  in  carbolized  water,  while 
this  proceeding  is  incapable  of  disinfecting  or  destroying  any 
germs  which  may  adhere  to  them,  may  yet  be  useful  in  an  antisep¬ 
tic  sense  i,  e.  by  destroying  microbes  in  a  developed  state  or  free¬ 
ing  them  from  the  supposed  secretion  by  which  they  may  be  sur¬ 
rounded,  and  which  may  serve  as  their  weapon  of  attack  by 
which  they  digest  or  destroy  the  surfaces  with  which  they  come 
directly  in  contact. 

14.  A  useful  precaution  on  the  part  of  the  operator  may  be 
a  bath  and  a  change  of  clothing,  the  hair  and  head  being  dam¬ 
pened  so  that  dust  will  not  escape  from  them ;  and  yet  another 
precaution  may  be  the  wearing  of  gowns  which  will  oblige  all 
dust  escaping  from  the  clothing  of  the  operator  and  his  assistants 
to  fall  to  the  floor  whence  it  may  escape  with  the  draft  which 
carries  out  the  lowest  stratum  of  the  air. 

Note.  The  construction  of  an  opemtin^  room  on  the  principles 
here  explained  in  a  hospital  already  built,  without  erecting  a  detached 
building,  would  require  tl»at  two  rooms  should  be  taken  one  above  the 
other  and  if  the  upper  one  can  have  a  skylight  it  will  be  of  great  advan¬ 
tage.  The  lower  room  might  be  in  the  basement  with  a  shaft  not  less 
thaif^fS)  three  feet  in  diameter  extending  to  the  upper  room  which  might 
be  un  '  -r  the  roof  for  the  advantage  of  a  skylight.  All  communications 
must  b^  Closed  by  brick  and  mortar  and  an  entrance  opening  made  in  the 
outer  WHi."  theapproach  being  secured  by  means  of  aphdform  on  the  out¬ 
side  of  the  building,  so  that  it  must  be  unavoidable  to  go  into  the  open 
air  for  entraiice  and  exit.  The  lower  room  should  be  equally  shut  off  from 
communiation  Afitli  other  rooms  of  the  building. 


I 


